Cortisol effects part two

July 28, 2015

Like everything else, too much is a bad thing, too little is a bad thing. You know, the stress response is something that keeps us alive and kept us alive throughout our evolutionary history. If it wasn't there, we couldn't survive and adapt in an ever-changing world. So it's absolutely essential to our survival. There's no doubt about that. The problem is the way that the stress response system was designed—or the way that it evolved over time was in a completely different environment than the environment that we're living in now. So it's not really set up for the kind of chronic, persistent stressors that we're experiencing today.

Functional disorders vs. diseases

Now back to Al's question. He mentioned Cushing's disease. This is a big area of confusion, the difference between what is often referred to as adrenal stress, adrenal fatigue or adrenal fatigue syndrome, which is a functional disorder—and I'm going to define that a little more clearly in a second here—and a disease like Cushing's disease. Because if you go to a conventional doctor and you say, "I think I have a problem with my adrenals," the first thing they're going to do is roll their eyes and say you've been reading too much on the Internet and to stop doing that. Then if you press them, they might say, "Okay. Well, we'll test you for Cushing's disease." You know, it's a disease. It's a clear, distinct pathology. It's characterized by increased secretion of ACTH in the anterior pituitary gland, which in turn, causes excess cortisol production. It's most commonly caused by a pituitary adenoma, which causes the increased secretion of ACTH or excess production of corticotropin-releasing hormone (CRH) in the hypothalamus. So this is a structural disease. It's a problem with the hormone-producing gland—in this case, the hypothalamus or the pituitary—that then causes the excess cortisol production at a very high level, and it leads to a condition called Cushing's syndrome, which is also a pretty distinct disease entity.

So when we talk about adrenal stress, adrenal fatigue syndrome, high cortisol or cortisol dysregulation, we are not talking about Cushing's disease. We're not talking about these clearly-defined disease entities. We're talking about a more functional disorder. What I mean by that is it's a condition that is measurable using objective lab findings, but it's not a clearly-defined disease entity. It's more of a syndrome.

There are lots of syndromes in medicine that are discussed and recognized by conventional doctors. One example would be irritable bowel syndrome (IBS), which is really nonsensical in a way when you look at it. If you really understand the diagnosis of IBS, it's a diagnosis of exclusion. You basically rule out a bunch of other potential conditions, like inflammatory bowel disease. Then if you rule all those other conditions out, the person gets this label of irritable bowel syndrome. It doesn't mean that irritable bowel syndrome is made up or it doesn't mean that the symptoms aren't real. It doesn't mean that there aren't real, actual, measurable things that you can detect in terms of people who have it. It just means that it's not a clearly-defined disease entity with a single etiology/cause and a single treatment. Another syndrome is premenstrual syndrome (PMS). That's a collection of signs and symptoms that are very real for women who experience it, but it's not a clearly-defined disease like type 2 diabetes, for example.

So adrenal fatigue syndrome I think is another syndrome. It's a collection of signs and symptoms which are measurable. We can look at a diurnal cortisol profile, which I'll talk about a little bit later, and we can see that cortisol is dysregulated. The production of it throughout the day might be too low in the morning and too high at night, or it might be a little bit high throughout the day or a little bit low throughout the day, but it's not high or low enough that it suggests Cushing's disease or one of these more clearly-defined disease entities. We're talking about things at a more functional level, at a level that hasn't evolved or may never evolve into a frank disease, but is nevertheless still very potentially debilitating. I mean, I have patients with severe adrenal fatigue syndrome, who can hardly get out of bed. You know, they're still told by their doctor that there's nothing wrong with them and they should probably just take an antidepressant. So I just want to be really clear about that right off the top, because there's so much confusion about what adrenal fatigue syndrome is and what it isn't. When we're talking here about high cortisol, we're not talking—I'm not talking about, at least—a situation where there's a structural problem. We're talking about a more functional disorder.